Krishna Jagatia et al.

Maternal and Fetal Outcome in Oligohydramnios

RESEARCH ARTICLE

MATERNAL AND FETAL OUTCOME IN OLIGOHYDRAMNIOS:

A STUDY OF 100 CASES
Krishna Jagatia, Nisha Singh, Sachin Patel
Smt NHL Municipal Medical College, Ahmedabad, Guajarat, India

Correspondence to: Krishna Jagatia (drhirenparmar@gmail.com)

DOI: 10.5455/ijmsph.2013.070520132 Received Date: 05.04.2013 Accepted Date: 07.05.2013

ABSTRACT
Background: Decrease in amniotic fluid volume or Oligohydramnios has been correlated with increased risk of
intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and
congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal
morbidity and mortality one side and decreased caesarean deliveries on the other side.
Aims & Objective: (1) To study affects Oligohydramnios on fetal outcome in form of (a) Fetal distress (b) Growth
retardation (c) NICU admission (2) To study APGAR scores of newborn babies in relation to Oligohydramnios (3) To
study incidence of congenital malformation (4) To study early neonatal morbidity and mortality (5) To study maternal
morbidity in form of operative delivery and induced labour.
Material and Methods: Present study was done over a period from May 2009 to November 2011. 100 patients in third
trimester of pregnancy with Oligohydramnios selected randomly after satisfying inclusion and exclusion criteria. A
detailed history and examination were done. All required investigation done. Oligohydramnios confirmed by measuring
AFI.
Results: Mean maternal age-23.66 years. Incidence of oligohydramnios was more in primipara (52%) in our study. And
operative morbidity was also more in primipara. Most common cause of Oligohydramnios is idiopathic (52%). Second
commonest cause is PIH (25%). Operative morbidity is highest in PIH (60%). Operative morbidity was significantly
higher in NST (non-stress test) non-reactive (3.12 ± 75=78.12%) group than NST reactive (26.47%) group. Most
common reason to perform caesarean was fetal distress which was either due to cord compression or IUGR. 7%
patients were found with fetoplacental insufficiency on Doppler study. Oligohydramnios was related to higher rate of
growth retardation and NICU (neonatal intensive care unit) admission.
Conclusion: Oligohydramnios is frequent occurrence and demands intensive fetal surveillance and proper antepartum
and intrapartum care. Due to intrapartum complication and high rate of perinatal morbidity and mortality, rates of
caesarean section are rising, but decision between vaginal delivery and caesarean section should be well balanced so
that unnecessary maternal morbidity prevented and other side timely intervention can reduce perinatal morbidity and
mortality.

KEY-WORDS: Oligohydramnios; Maternal Outcome; Fetal Outcome

Introduction method of amniotic fluid estimation by Amniotic

Nature has made floating bed in foam of amniotic
fluid cavity filled with liquor amnii for the
requirement of fetus, for its existence and growth
in sterile environment, regulation of temperature,
avoidance of external injury and reduction of
impact of uterine contractions. Decrease in
amniotic fluid volume or Oligohydramnios[1] has
been correlated with increased risk of
intrauterine growth retardation, meconium
aspiration syndrome, severe birth asphyxia, low
APGAR scores and congenital abnormities.[2]
Oligohydramnios is also associated with maternal
morbidity in form of increased rates of induction
and/ or operative interference.[3] With the help of
fluid Index (AFI) using four quadrant technique
during transabdominal USG, as per described by
Phelan et al[4] in 1997, better identification of
fetus at high risk can be done. Which was
otherwise difficult in past by clinical estimation of
amniotic fluid done? Increased induction of labour
and elective caesarean deliveries are currently
practiced for better perinatal outcome. Early
detection of oligohydramnios and its management
may help in reduction of perinatal morbidity and
mortality one side and decreased caesarean
deliveries on the other side. Since Oligo-
hydramnios has got significant impact on neonatal
outcome and material morbidity, it prompted us
to study the condition as my thesis subject.

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 Krishna Jagatia et al. Maternal and Fetal Outcome in Oligohydramnios

Materials and Methods 55.78 ± 1.92) (Table 2). Most common cause of
Oligohydramnios is idiopathic (52%). Second
Present study was done over a period from May commonest cause is PIH (25%). Operative
2009 to November 2011. 100 patients in third morbidity is highest in PIH (60%) (Table 3).
trimester of pregnancy with Oligohydramnios Operative morbidity was significantly higher in
selected randomly after satisfying inclusion and NST non-reactive (78.12%, 3.12 ± 0.75) group
exclusion criteria. Inclusion Criteria: Antenatal than NST reactive (26.47%) group (Table 4).
patients in their third trimester with intact
membranes. Exclusion Criteria: Antenatal patients All patients were undergone Doppler study. 7%
having heart diseases, Polyhydramnios, were found with fetoplacental insufficiency. In
premature rupture of membranes, twins and present study, 25 patients had induction of labour.
multiple pregnancies. Out of them cerviprim was used in 18 and
misoprost in 4 and oxytocin in 3 patients. It
Study was conducted to observe outcome of showed 64% vaginal delivery and 36% caesarean
labour in form of perinatal morbidity and section (Table 5). Most common reason to
maternal outcome in form of induction and perform caesarean was fetal distress which was
deliveries: (1) To study affects Oligohydramnios either due to cord compression or IUGR (Table 6).
on fetal outcome in form of – (a) Fetal distress, (b) Oligohydramnios was related to higher rate of
Growth retardation, (c) NICU admission; (2) To growth retardation and NICU admission (Table 7).
study APGAR scores of newborn babies in relation In NST Reactive group 1 baby expired due to
to Oligohydramnios; (3) To study incidence of septicaemia and another expired due to HMD and
congenital malformation; (4) To study early LBW. In NST Non-Reactive group both babies
neonatal morbidity and mortality; (5) To study expired due to meconium aspiration syndrome +
maternal morbidity in form of operative delivery acute respiratory distress syndrome (Table 8).
and induced labour.
Table-1: Age and Maternal Outcome of Labour
Vaginal Delivery
A detailed history and examination were done. All Age Caesarean Total
Normal Assisted (Forceps)
required investigation done. Oligohydramnios < 20 3 (75%) 0 1 (25%) 4
confirmed by measuring AFI. Routine 20-25 39 (58.2%) 1 (1.5%) 27 (40.3%) 67
26-30 10 (43.48%) 0 13 (56.52%) 23
management in form of rest, left lateral position, ˃ 30 5 (83.3%) 0 1 (16.66%) 6
oral and intravenous hydration and control of Total 100
etiological factor was done if present. Fetal
Table-2: Parity and Maternal Outcome of Labour
surveillance was done by USG, modified
Vaginal Delivery
Biophysical profile and Doppler. Decision of Parity Caesarean Total
Normal Assisted
delivery by either induction or elective or Primipara 22 (42.30%) 1 (1.92%) 29 (55.78%) 52
emergency LSCS was done as per required. Some Multipara 35 (72.91%) 13 (27.09%) 48
Total 100
patients were already in labour and other allows
going in spontaneous labour. Cases were than Table-3: Associated Condition and Maternal Outcome
studied for maternal and perinatal outcome. of Labour
Vaginal Delivery
Parity Caesarean Total
Normal Assisted
Results Pregnancy Induced
10 (40%) 0 15 (60%) 25
Hypertension
67% of patients were in 20-25 years age group Postdates 13 (65%) 0 7 (35%) 20
and 23% patients were in 26-30 years age group. Fever 3 (100%) 0 0 3
Idiopathic 31 (59.61%) 1 (1.92%) 20 (38.47%) 52
Thus, maximum patients were in 20-30 years age Total 100
group. Rate of caesarean was highest in 26-30
years and lowest in patients of >39 years of age. Table-4: Non-Stress Test (NST)
Vaginal Delivery
Mean maternal age was 23.66 years (Table 1). NST
Normal Assisted
Caesarean Total
Incidence of oligohydramnios was more in Reactive 50 (73.53%) 0 18 (26.47%) 68
primipara (52%) in our study. And operative Non-reactive 7 (21.88%) 1 (3.12%) 24 (75%) 32
morbidity was also more in primipara (57.7%, Total 100

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 Krishna Jagatia et al. Maternal and Fetal Outcome in Oligohydramnios

Table-5: Doppler birth weight but healthy and did not required
Vaginal Delivery NICU admission. It was comparable to Gramellini
Doppler Caesarean Total
Normal Assisted
Normal 57 (61.29%) 1 (1.07%) 36 (38.71%) 93 D et al[13] where amnioinfusion was significantly
Abnormal 1 (14.29%) 0 6 (85.71%) 7 gestation and reduced neonatal mortality. In
Total 100 present study, 36% babies had weight < 2.5 kg.
Table-6: Indication of Caesarean Section
Mean birth weight was 2.33 kg which is similar to
Indication % of Patients the study conducted by William Ott et al[14] with
Fetal distress 21% the mean birth weight was 2.4 kg. The incidence of
Oligohydramnios 9% low birth weight babies is higher in
FPI, IUGR 8%
Breech 2% Oligohydramnios except in post maturity where
Other 2% the babies may have average birth weight. In Julie
Johnson et al[15], 92.6% babies were AGA and 7%
Table-7: Outcome of Baby
were SGA. In Brain M Casey et al[16] 75.5% AGA
Outcome % of Patients
Growth retardation 82 (AGA); 18 (SGA) and 24% SGA. In Philipson EH et al[17] 60% AGA
APGAR score < 7 in 1 to 5 mints 15 and 40% SGA. In Manning et al[18] 64% AGA and
NICU admission 22 36% SGA. In Raj Sariya et al[19] 83.4% AGA and
Table-8: Attributes Related to Domestic Violence 16.6% SGA. This high percentage of SGA babies
[Frequency of Violence] suggesting correlation of IUGR with Oligo-
Perinatal Outcome NST Reactive NST Non-Reactive hydramnios. In Manning et al[18] 15% babies had
Live 66 30
Neonatal death 2 2
APGAR score < 7. In Raj Sariya et al[19], it was 38%.
In Julie M Jhonson et al[15] 20% babies had NICU
Discussion admission. In Manning et al[18] and Raj Sariya et
al[19], 43% and 88.88% respectively. Golan et al[20]
In Casey et al[5], the mean maternal age was 23.9 show 6.3% neonatal death in deliveries of
years which is comparable to the present study. In Oligohydramnios patients which is observed our
Donald D et al[6], the incidence of oligohydramnios study.
was 60% in primigravida which is comparable to
present study as it was 52%. Sir Gangaram Conclusion
Hospital study[7] shows 68% vaginal deliveries in
induced patients of Oligohydramnios and 32% by Oligohydramnios is frequent occurrence and
caesarean section which is comparable to our demands intensive fetal surveillance and proper
study. Manzanares S et al[8] shows 84% vaginal antepartum and intrapartum care. Oligo-
deliveries in induced patients of Oligohydramnios hydramnios is a frequent finding in pregnancy
and 16% by caesarean section. In this study, in involving IUGR, PIH, and pregnancy beyond 40
spite of non-reactive NST 25% patients delivered weeks of gestation. Amniotic fluid volume is a
vaginally. The caesarean section was done more predictor of fetal tolerance in labour and its
commonly in 755 patients with non-reactive NST decrease is associated with increased risk of
as seen in Charu Jandial study.[9] As these patients abnormal heart rate and meconium stained fluid.
had oligohydramnios, a non-reactive NST + AFI < Due to intrapartum complication and high rate of
5 indicated fetal jeopardy as per revised perinatal morbidity and mortality, rates of
Biophysical profile scoring by Clerk et al.[10] The caesarean section are rising, but decision between
fetal jeopardy was reflected as increase operative vaginal delivery and caesarean section should be
interference in this study. well balanced so that unnecessary maternal
morbidity prevented and other side timely
The operative morbidity is significantly higher in intervention can reduce perinatal morbidity and
patients with altered Doppler study. In Weiss et mortality.
al[11] and Yound HK et al[12], it was 71% and 69.7%
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Cite this article as: Jagatia K, Singh N, Patel S. Maternal
and fetal outcome in oligohydramnios: A study of 100
cases. Int J Med Sci Public Health 2013; 2:724-727.
Source of Support: Nil
Conflict of interest: None declared